GUEST Application Request - BIBLE CONFERENCE RETREAT

thank you for your interest in attending the bible conference retreat. To receive a prospective GUEST application packet, please read the following and complete the form below.

Confidentiality and Consent Information: Handi*Camp is committed to protecting your privacy. The information provided below will be used to evaluate care needs and determine the appropriateness of attendance at Retreat. Information provided will only be shared with relevant Handi*Camp personnel. By submitting this form, you consent to the collection, storage, and use of the guest’s information. If you are NOT comfortable providing this initial information online, please CALL our office to speak with a camp staff member who will be happy to assist you in completing this form by phone. (717.859.4777)

NOTE: Once you receive your forms, complete them as soon as possible. ALL forms are DUE AT THE CAMP OFFICE no later than march 7, 2025. Earlier is better, as spaces fill “first-come, first-served” based on the final completion date of ALL your forms.

Prospective guest:

First Name

Last Name

Guest's birthdate:

YYYY

Guest's age:

Guest's gender:

Guest's disability:

Please describe. If none, type "none."

Is there any INTELLECTUAL component to guest's disability?

Has guest attended BIBLE CONFERENCE before?

Primary contact for paperwork:

First Name

Last Name

Relationship to prospective guest:

Primary contact's phone number for application process:

(###)

###

####

Mailing address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Be sure this is an ACTIVE, MONITORED email. Handi*Camp will use this address to correspond with you during the application process.

In the last five years, has prospective guest had ANY SEIZURE ACTIVITY and/or been diagnosed with a SEIZURE DISORDER?

If YES, an additional SEIZURE FORM will be included in your packet.

In the last five years, has the prospective guest had a diagnosis of ASTHMA and/or used an INHALER?

If YES, an additional ASTHMA FORM will be included in your packet.

In the last five years, has the prospective guest been diagnosed with DIABETES or PRE-DIABETES?

If YES, an additional DIABETES FORM will be included in your packet.

Does prospective guest have a feeding tube?

If YES, an additional FEEDING TUBE FORM will be included in your packet.

Will the prospective guest be taking ANY MEDICATIONS, SUPPLEMENTS or TREATMENTS (prescription, PRN, OTC, etc.) while at retreat?

If YES, an additional MED FORM will be included in your packet.

Additional comments:

Handi*Vangelism Ministries International

Handi*Vangelism Ministries International

Guest Application Request - RETREAT

Handi*Vangelism Ministries International

GUEST Application Request - BIBLE CONFERENCE RETREAT

thank you for your interest in attending the bible conference retreat. To receive a prospective GUEST application packet, please read the following and complete the form below.

NOTE: Once you receive your forms, complete them as soon as possible. ALL forms are DUE AT THE CAMP OFFICE no later than march 7, 2025. Earlier is better, as spaces fill “first-come, first-served” based on the final completion date of ALL your forms.

Handi*Vangelism Ministries International

MAILING ADDRESS: PO Box 122, Akron PA 17501-0122

physical Headquarters: 3261 ROTHSVILLE ROAD, AKROn pa 17501

CONTACT US | PHONE: 717.859.4777

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